BVA9508377
DOCKET NO. 93-07 307 ) DATE
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On appeal from the decision of the
Department of Veterans Affairs Medical Center, Cincinnati, Ohio
THE ISSUE
Whether the veteran's claim for reimbursement or payment of the
cost of unauthorized medical services was timely filed.
REPRESENTATION
Appellant represented by: Disabled American Veterans
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
Hilary L. Goodman, Counsel
INTRODUCTION
The veteran had active service from March 1968 to September 1969.
This appeal arises from a determination, apparently made in
October 1992, concluding that the veteran's claim for
reimbursement or payment of the cost of unauthorized medical
services was not timely filed.
The Board of Veterans' Appeals (Board), in a December 1994
remand, noted that the veteran had also raised the issue of
entitlement to reimbursement or payment for the cost of an
ambulance. This issue is again referred to the clinic of
original jurisdiction for appropriate action.
REMAND
The representative had previously requested that the original
medical administrative services file be obtained and that copies
of the veteran's July 28, 1990, treatment records and all of the
hospital bills issued to the veteran by St. Luke Hospital, East,
be secured. The representative had noted that the local
representative was not given the opportunity to complete VA Form
1-646.
Essentially, it is contended inter alia that the evidence raises
the possibility that a claim for payment of the expenses in
question had been filed by a health care provider within the
regulatory 2 year period. In this regard, it is contended that
the bill the veteran received in August 1990 from Emergency Care
Physicians of Northern Kentucky contains the notation "THIS BILL
IS NOW YOUR RESPONSIBILITY, YOUR ACCOUNT REMAINS UNPAID..."
The Board, in the previous remand, requested that the complete
administrative and clinical records pertaining to the veteran's
treatment on July 28, 1990, at St. Luke Hospital, East, Fort
Thomas, Kentucky, be obtained and indicated that the original VA
medical administrative records should be associated with the
claims file. It was noted that, if the benefit sought by the
veteran remained denied, a supplemental statement of the case
which included a summary of the evidence received since the
December 1992 statement of the case should be issued to the
veteran and his representative.
It appears that the veteran's claim for payment or reimbursement
of the expense of July 1990 treatment ($131) relates to the fee
charged by Emergency Care Physicians of Northern Kentucky.
The current record does not include the original VA or non-VA
medical administrative records and does not show that a
supplemental statement of the case was issued to the veteran and
his representative or that the representative has been given the
opportunity to review the claims file. Having reviewed the
record, it is the opinion of the Board that this case must be
REMANDED to the clinic of original jurisdiction for the following
action:
1. The agency of original jurisdiction
should take the necessary steps to obtain
legible copies of the complete clinical and
administrative records (particularly
including bills for payments) pertaining to
the July 28, 1990 treatment from St. Luke
Hospital and from Emergency Care Physicians
of Northern Kentucky. Any records obtained
should be associated with the claims
folder.
2. The original VA medical administration
records referable to the veteran, or
legible copies thereof, should be obtained
and associated with the claims folder.
3. The clinic of original jurisdiction
should thereafter review the veteran's
claim. Should the benefit sought by the
veteran remain denied, a supplemental
statement of the case which includes a
summary of the evidence received since the
December 1992 statement of the case must be
issued to the veteran and his
representative. Both the veteran and his
representative should be given the
appropriate period of time to respond.
Thereafter, subject to current appellate procedure, the case,
including all evidence developed, should be returned to the
Board for further consideration, if otherwise in order. The
purpose of this REMAND is to secure clarifying data and ensure
due process. No action is required of the veteran unless he
receives further notice.
JAMES R. ANTHONY
Member, Board of Veterans' Appeals
The Board of Veterans' Appeals Administrative Procedures
Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___
(1994), permits a proceeding instituted before the Board to be
assigned to an individual member of the Board for a
determination. This proceeding has been assigned to an
individual member of the Board.
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of a
preliminary order and does not constitute a decision of the Board
on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1994).